Burn Injuries and Social Security Disability Benefits

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By Deanna Power

Soft tissue burns range in severity from minor skin reddening to serious and life-threatening injuries that require multiple surgeries and months of physical therapy. If you have suffered third- or fourth-degree burns, you will likely not be able to work until they have healed; and in a worst-case scenario you may be permanently disabled.

The latter prospect, combined with high medical bills, can cause a lot of anxiety and financial distress. If certain qualifications are met, the Social Security Administration (SSA) may extend disability benefits when you are unable to work due to burn injuries.

What Disability Benefits Are Available?

There are 2 types of SSA benefits available for those who require financial assistance due to injury or illness. While the medical eligibility requirements are the same, each benefit has its own specific technical eligibility.

  • Social Security Disability Insurance (SSDI): SSDI is intended for those who have worked in the recent past and become too disabled to continue. Eligibility is contingent on how much Social Security tax you have paid during your employment history. To qualify for SSDI, you must have earned enough “work credits” throughout employment to qualify. A work credit is an amount of taxable income, $1,220 in 2016. You can earn up to 4 work credits per year. The amount of work credits you will need to qualify will depend on how old you are when you apply. The Benefits Planner on the SSA website includes a chart that lists exactly how many credits you’ll need when you apply. If you haven’t earned enough work credits for your age at the time at which you apply, you will only qualify for Supplemental Security Income.
  • Supplemental Security Income (SSI): SSI is needs based and aimed at applicants with little to no income, such as children and the elderly. Anyone who makes more than $733 a month does not qualify, although if you are applying on behalf of a child with burn injuries, the SSA will not be as strict when evaluating your income. It is important to know that if you have a spouse who earns a living wage, you will not qualify for SSI benefits, regardless of how severe your burns are.

If you meet the financial requirements for SSDI or SSI, the next evaluation is based on medical criteria listed in the “Blue Book,” a manual that lists qualifying conditions for disability. Burn injuries are assessed using 1 of 2 listings.

Medically Qualifying for SSA Benefits With Burn Injuries Requiring Surgery

Blue Book listing 1.08: Soft Tissue Injury covers burns that are still being treated surgically. To qualify, you must supply the following:

  • Documentation indicating that a surgeon is working to restore functionality to the injured area, which includes your face and head, limbs, or torso
  • Records proving that the injured areas have limited functionality
  • A doctor’s estimate as to when the area will be functional again, if ever

While most disability applicants are revaluated by the SSA every 3 years, you can expect to be evaluated by the SSA much sooner if approved under Blue Book listing 1.08. This is because you have a stronger chance of recovery if a doctor is performing surgeries in the hope of improving your condition.

Medically Qualifying for SSA Benefits With Burn Injuries Without Surgery

Burns that are no longer being treated surgically are referenced in Blue Book listing 8.08: Burns. To be eligible for disability under this listing, you must prove that you have extensive and debilitating skin lesions that have lasted or are expected to last a minimum of 1 year.

An “extensive” or “debilitating” skin lesion includes a burn that prevents you from working. For example, if you experience severe burns on your hands and subsequently have limited function of your arms and hands, you could be approved if you worked at a job that requires use of your hands, such as a software engineer.

You can also be approved if the pain from your burns keeps you from working. For example, a software engineer will not need her legs to be functioning perfectly to do her job, but if she experiences severe burns on her legs and is unable to manage the pain through medication, then she may be approved for disability benefits.

The SSDI and SSI Application Process

When applying for SSA disability benefits, you will be required to fill out and submit a detailed application form, accompanied by medical documentation, such as the following:

  • A doctor’s statement that includes your original diagnosis, treatment, and prognosis
  • The surgeon’s report (if the burns required surgical treatment)
  • Physical therapy records
  • Prescription records and records of all attempted treatments

The more medical documentation you are able to provide  in your application, the better your chances of being approved for burn injuries. If you have your own medical records on hand, you should submit these yourself to the SSA. It’s not necessary for applying, but submitting your own records will expedite the application process, as the SSA itself will not need to contact your doctors.

If your burn injuries do not meet or equal a Blue Book listing, you may still qualify for benefits if your doctor provides a detailed report on how the burns prevent you from doing work for which you are qualified. The SSA will assess your ability to function using a residual functional capacity (RFC) form, which examines physical, mental, and sensory impairments.

For more information about SSA disability benefits and how to apply for them, visit the SSA’s website,www.ssa.gov, or go to your local SSA office. You can schedule an appointment with your local office by calling the SSA tollfree at 1-800-772-1213. It is advisable to call the SSA to set up an in-person interview before applying online.

Speaking with the SSA over the phone will give you a better idea of whether or not you’ll qualify, potentially saving you hours of work applying.

It is important to note that after you apply, it may take 4 to 6 months to get a response from the SSA as to whether or not you were approved. Keep in mind that SSDI recipients will be retroactively paid for any time waiting for approval after 5 months; SSI recipients will be entitled to payments for any waiting periods over 1 month. Once your application is approved, you will be able to focus on recovery rather than finances.

This article was contributed by Social Security Disability Help, an independent organization dedicated to helping people of all ages receive disability benefits. Their website is www.disabilitybenefitscenter.org. For any additional information or assistance, their staff can be reached at help@disabilitybenefits- help.org.

 

Deanna Power is the Director of Community Outreach for Social Security Disability Help. She first began working with people with disabilities by volunteering with Best Buddies throughout college, and now specializes in helping people determine whether they medically qualify for disability benefits.

 

This story is an excerpt from The Phoenix Society’s® Burn Support Magazine, Issue 2, 2016.  Burn Support Magazine is a tri-annual publication that contains articles on the emotional, psychological, and social aspects of burn recovery.  All Rights Reserved.
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